Resource utilization in esophagectomy: When higher costs are associated with worse outcomes. Issue 1 (17th July 2015)

• Record Type: Journal Article
• Authors: Gaitonde, Shrawan G.; Hanseman, Dennis J.; Wima, Koffi; Sutton, Jeffrey M.; Wilson, Gregory C.; Sussman, Jeffrey J.; Ahmad, Syed A.; Shah, Shimul A.; Abbott, Daniel E.
• Is Part Of: Journal of surgical oncology. Volume 112:Issue 1(2015:Jul. 01)
• Page Start: 51
• Page End: 55
• Publication Date: 2015-07-17
• Subjects: Cancer -- Surgery -- Periodicals; Neoplasms -- Periodicals; 616
• DOI: 10.1002/jso.23958
• Languages: English
• ISSNs: 0022-4790

Abstract

<abstract abstract-type="main" xml:lang="en"> <title> <x xml:space="preserve">Abstract</x> </title> <sec id="jso23958-sec-0001" sec-type="section"> <title>Introduction</title> <p>Care of the esophagectomy patient requires significant resources. We sought to determine which patient and provider variables contribute to resource utilization and their association with clinical outcomes.</p> </sec> <sec id="jso23958-sec-0002" sec-type="section"> <title>Methods</title> <p>6, 737 patients undergoing esophagectomy were identified from the University Healthsystem Consortium (UHC). Linear and logistic regression models were used to determine whether characteristics, including age, severity of illness (SOI) and procedural volume were associated with mortality, length of stay (LOS), discharge disposition, readmission rates, and cost.</p> </sec> <sec id="jso23958-sec-0003" sec-type="section"> <title>Results</title> <p>Older patients were twice as likely to suffer post‐operative death (OR 2.12; 95%CI 1.7–2.7), three times more likely to be discharged to extended care facilities (31.9% vs. 10.6%, <italic>P</italic> < 0.001), and cost 8.4% more ($27, 628 vs. $25, 481, <italic>P</italic> < 0.001). Similarly, patients with higher SOI were more likely to suffer post‐ operative death (OR 14.6; 4.7–45.9), be readmitted (OR 1.3; 1.1–1.6), and have longer hospital stays (RR 1.3; 1.8–2.1). Patients with the highest index hospital costs were five times more likely to be discharged to an extended care facility (<italic>P</italic> < 0.001).</p> </sec> <sec id="jso23958-sec-0004" sec-type="section"> <title>Conclusion</title> <p>Older patients and those with a higher SOI have higher perioperative mortality, readmission rates, hospital costs, and require more post‐ operative care. With increasingly scrutinized health care costs, these data provide guidance for more careful patient selection. <italic>J. Surg. Oncol. 2015 111:51–55</italic>. © 2015 Wiley Periodicals, Inc.</p> </sec> </abstract>